Disseminating Lessons Learned From Serious Incidents (SI): Multidisciplinary Ward Based Simulation and Bite-Sized-Teaching

Abstract

Aims

Improve staff confidence in responding to and managing ward based medical emergencies

Methods

The deputy borough lead nurse, a clinical nurse manager and a core trainee met to discuss how to build confidence across all staff in responding to ward-based medical emergencies following a number of recent SI.

Initially, weekly ward-based simulations were conducted. Scenarios were SI focused and included choking, drug overdose, head injury and hanging. Whilst it was clear there was an appetite for learning and upskilling, unannounced simulations did not appear to foster a relaxed, productive learning environment conducive to building confidence.

Following four weeks of simulation, the approach was altered. Instead of unannounced simulations, sessions were broken down into three parts. Firstly, each session began with a brainstorm of ‘key roles for any medical emergency’ (call for help, vital signs, scribe…), this was followed by a skills session on key topics. Areas for learning were identified following an MDT discussion and staff feedback focus group. These were; 1. Grab bag orientation, 2. Oxygen delivery, 3. SBAR handover, 4. Operating the suction machine, 5. A-E assessment. Finally, all sessions ended with practicing CPR on first aid training manikins. Sessions ran once or twice a week, depending on availability, rotating through the seven inpatient wards. Each session lasted approximately 20 minutes and two sessions were run back-to-back in order to ensure where possible every staff member working that shift was able to attend. These sessions have been running since mid-September. To date we have run a total of twelve sessions conducted both in and out-of-hours. After each session participants were asked to fill out feedback.

A ‘flash card’ aid providing quick action prompts applicable to all medical emergencies was drafted and reviewed by the trust's resuscitation lead for inclusion in ward emergency grab bags.

In addition to ward based teaching, grab-bag orientation sessions were run during doctor's induction.

Results

Ward based learning:

Sessions were attended by nurses, social therapists, occupational therapists and doctors of all grades. Approximately sixty people have attended the bite-sized teaching to date. All participants across all sessions found the teaching useful and relevant.

Junior doctor induction:

All attendees at the inductions strongly agreed the session was useful. 100% agreed that the session helped to increase their confidence around responding to medical emergencies with 78% strongly agreeing. All participants strongly agreed the session improved confidence in utilising the emergency grab bag.

Conclusion

People with severe mental illness are at greater risk of poor physical health and have higher premature mortality than the general population. Responding to medical emergencies in the psychiatric inpatient setting is a source of anxiety for most staff. Currently, nursing staff in psychiatric settings are required to have ILS training, many feel this annual course is insufficient. The majority of the emergency response team have BLS or no physical health training at all. Lone doctors, unfamiliar with available emergency equipment and psychiatric settings lack confidence to act optimally.

There is a great appetite for regular emergency physical health training. Our weekly sessions were well received, useful and relevant.